ANALISIS PERFORMANCE PRISM SEBAGAI DASAR PENYUSUNAN UPAYA PENURUNAN ANGKA KEMATIAN IBU (AKI) DI KABUPATEN LUMAJANG Repository - UNAIR REPOSITORY

  SUMMARY PERFORMANCE PRISM ANALYSIS AS A BASIS FOR DEVELOPING EFFORTS TO REDUCE MATERNAL MORTALITY RATE (MMR)

IN LUMAJANG DISTRICT

  Maternal Mortality Rate (MMR) is a sensitive indicator in describing the health of mothers, even the welfare of society in a country because of its sensitivity to the improvement of health services in terms of both accessability and quality. High maternal mortality rate in the country basically describes a low status of public health and has the potential to cause economic and social deterioration in the household, community and national levels. Trend of Maternal Mortality Rate (MMR) in Lumajang District tended to fluctuate from the year 2013 to the month of June 2018. MMR was always above the target in the year 2013-2016 but in 2017 it decreased drastically under SDG's target amounting to 70 of 100,000 live births. In June 2018 there was 9 maternal mortality with the MMR was 59 of 100,000 live births. Compared with the number of deaths in the same month in 2017, there was an increase in maternal mortality. It can be estimated that maternal mortality will possibility keep increasing until the end of 2018 if there is no optimal interventions.

  Based on the recommendation of the Ministry of Health, reducing maternal mortality rate can be achieved by increasing coverage and quality of maternal health and maternity as well as increased partnerships with all stakeholders involved. Therefore, researchers are looking for the cause of the problem of high maternal mortality rate (MMR) in Lumajang with a view of the stakeholders. The involvement of stakeholders in the success of the program were analyzed by first identifying stakeholder satisfaction and stakeholder contribution to the performance prism framework. The purpose of this study was to develop on efforts to reduce Maternal Mortality Rate (MMR) based on performance prism in Lumajang. The specific objectives of this research was: (1) Identified the key stakeholders in maternal health care programs in health centers; (2) Identified stakeholder satisfaction to maternal health services in health centers; (3) Indentified the contribution required of stakeholders in maternal health services in health centers; (4) Analyzed the strategies, processes, and capabilities that health center that formulated by PHC which can be used to improve maternal health services in health centers; (5) Analyzed Key Performance Indicator (KPI) of strategy, process, and capability in improving maternal health care in Lumajang District; (6) Analyzed the priority KPI with Analytical Hierarchy Process (AHP); (7) Analyzed the performance of maternal health cares based on a priority of KPI; (8) Developed recommendations to decrease the maternal mortality ratio (MMR) in Lumajang District.

  This study was an observational study with descriptive and quantitative approach and cross-sectional study design. The study was conducted in three health centers in Lumajang with AKI categories of low, medium, and high. The respondents are the key stakeholders of maternal health care programs, among others: (1) Regulator (Department of Health and the Regional Planning Board Lumajang); (2) Employee (officers Hospital, Head of the Health Center, doctors, midwives and medical analyst or nutritionist in health centers); (3) Customer (pregnant women); and (4) intermediaries (community, village government, and district).

  Identification of stakeholders satisfaction and contribution resulted in the formulation of KPI program maternal health services in Lumajang as much as 23 KPI consisted of 14 KPI regulator (4 KPI strategies, 4 KPI process, and 6 KPI capability), 5 KPI employee (2 KPI strategies, 2 KPI process and 1 KPI capability), and 4 KPI intermediaries (1 KPI strategies, 1 KPI process, and 2 KPI capability).

  Performance measurement in 10 priority KPI based performance prism resulted in the conclusion that the performance of maternal health services programs in Gesang PHC was good with a total value performance was 77.5%, Rogotrunan PHC was enough with a total value of performance was 51.05%, Pasirian PHC was poor with the total value of the performance was 42.5%. Based on the results of this study concluded that performance improvement of maternal health care programs may affect the reduction in the number of maternal deaths.

RINGKASAN ANALISIS PERFORMANCE PRISM SEBAGAI DASAR PENYUSUNAN UPAYA PENURUNAN ANGKA KEMATIAN IBU (AKI) DI KABUPATEN LUMAJANG

  Angka Kematian Ibu (AKI) merupakan indikator yang peka dalam menggambarkan derajat kesehatan ibu, bahkan kesejahteraan masyarakat di suatu negara karena sensitifitasnya terhadap perbaikan pelayanan kesehatan baik dari segi aksesibilitas maupun kualitas. AKI yang tinggi di suatu wilayah pada dasarnya menggambarkan derajat kesehatan masyarakat yang rendah dan berpotensi menyebabkan kemunduran ekonomi dan sosial di level rumah tangga, komunitas, dan nasional. Tren Angka Kematian Ibu (AKI) sejak Tahun 2013 sampai dengan bulan Juni 2018 cenderung fluktuatif, pada Tahun 2013-2016 AKI di Kabupaten Lumajang selalu berada di atas target, pada Tahun 2017 mengalami penurunan drastis hingga berada di bawah target SDG’s sebesar 70 per 100.000 kelahiran hidup. Namun pada Tahun 2018 sampai dengan data capaian bulan Juni 2018 diketahui sudah terjadi 9 kematian ibu dengan AKI sebesar 59 per 100.000 kelahiran hidup. Jika dibandingkan dengan jumlah kematian Tahun 2017 pada periode yang sama maka dapat diperkirakan bahwa kemungkinan masih akan terjadi kenaikan AKI sampai dengan akhir Tahun 2018 jika tidak dilakukan upaya intervensi yang lebih optimal.

  Berdasarkan rekomendasi Kementerian Kesehatan, penurunan AKI dapat dicapai dengan peningkatan cakupan dan kualitas pelayanan kesehatan ibu hamil dan bersalin serta peningkatan kemitraan dengan seluruh stakeholder yang terlibat. Oleh karena itu peneliti mencari penyebab masalah tingginya Angka Kematian Ibu (AKI) di Kabupaten Lumajang dengan melihat dari sisi stakeholder. Keterlibatan stakeholder dalam keberhasilan program dianalisis dengan terlebih dahulu mengidentifikasi kepuasan stakeholder dan kontribusi stakeholder dengan kerangka performance prism. Tujuan penelitian ini adalah menyusun rekomendasi upaya penurunan Angka Kematian Ibu (AKI) berdasarkan performance prism di Kabupaten Lumajang. Tujuan khusus penelitian antara lain: (1)Mengidentifikasi

  stakeholder kunci dalam program pelayanan kesehatan ibu di Puskesmas; (2)

  Mengidentifikasi stakeholder satisfaction terhadap pelayanan kesehatan ibu di Puskesmas; (3) Mengidentifikasi stakeholder contribution yang dibutuhkan dalam pelayanan kesehatan ibu di Puskesmas; (4) Menganalisis strategi, proses, dan kapabilitas Puskesmas yang dirumuskan oleh Puskesmas untuk meningkatkan pelayanan kesehatan ibu di Kabupaten Lumajang; (5) Menganalisis Key

  Performance Indicator (KPI) dari strategi, proses, dan kapabilitas yang

  dirumuskan oleh Puskesmas untuk meningkatkan pelayanan kesehatan ibu di Kabupaten Lumajang; (6) Menganalisis hasil penentuan prioritas KPI dengan metode Analytical Hierarchy Process (AHP); (7) Menganalisis kinerja pelayanan kesehatan ibu berdasarkan prioritas KPI yang ada; (8) Menyusun rekomendasi untuk menurunkan Angka Kematian Ibu (AKI) di Kabupaten Lumajang.

  Penelitian ini adalah penelitian observasional dengan metode deskriptif dan pendekatan kuantitatif serta disain penelitian cross sectional. Penelitian dilakukan di 3 Puskesmas di Kabupaten Lumajang dengan kategori AKI rendah, sedang, dan tinggi. Data KPI dianalisis dengan metode Analytical Hierarchy Process (AHP). Responden penelitian adalah stakeholder kunci dari program pelayanan kesehatan ibu antara lain: (1) Regulator (Dinas Kesehatan dan Badan Perencanaan Pembangunan Daerah Kabupaten Lumajang); (2) Employee (petugas Rumah Sakit, Kepala Puskesmas, dokter, bidan dan pelaksana ANC Terpadu lainnya yaitu analis medis atau pelaksana gizi di Puskesmas); (3) Customer (ibu hamil); dan (4) Intermediaries (tokoh masyarakat, pemerintah desa, dan kecamatan).

  Identifikasi kepuasan dan kontribusi stakeholder menghasilkan rumusan KPI program pelayanan kesehatan ibu di Kabupaten Lumajang sebanyak 23 KPI yang terdiri dari 14 KPI regulator (4 KPI strategi, 4 KPI proses, dan 6 KPI kapabilitas), 5 KPI employee (2 KPI strategi, 2 KPI proses, dan 1 KPI kapabilitas), dan 4 KPI intermediaries (1 KPI strategi, 1 KPI proses, dan 2 KPI kapabilitas).

  Pengukuran kinerja pada 10 KPI prioritas berdasarkan performance prism menghasilkan kesimpulan bahwa kinerja program pelayanan kesehatan ibu di Puskesmas Gesang termasuk dalam kategori baik dengan total nilai kinerja sebesar 77,5%, Puskesmas Rogotrunan termasuk dalam kategori cukup baik dengan total nilai kinerja sebesar 51,05%, Puskesmas Pasirian termasuk dalam kategori kurang baik dengan total nilai kinerja adalah 42,5%. Berdasarkan hasil penelitian dapat disimpulkan bahwa peningkatan kinerja program pelayanan kesehatan ibu dapat mempengaruhi penurunan jumlah kematian ibu di wilayah kerja Puskesmas.

  ABSTRACT PERFORMANCE PRISM ANALYSIS AS A BASIS FOR DEVELOPING EFFORTS TO REDUCE MATERNAL MORTALITY RATE (MMR)

IN LUMAJANG DISTRICT

  Trend of Maternal Mortality Rate (MMR) in Lumajang District tended to fluctuate since 2013 to June 2018. MMR was above the target in 2013-2016, but in 2017 it decreased drastically under target of Lumajang Health Office amounted 102 of 100,000 live birth. Compared with the number of deaths in the same month in 2017, there was an increase in maternal mortality. Based on the recommendation from Ministry of Health, reducing maternal mortality rate could be achieved by increasing coverage and quality of maternal health and maternity as well as increasing partnerships with all stakeholders involved. Therefore, researchers are looking for the cause of the problem of high maternal mortality rate (MMR) in Lumajang with point of view from the stakeholders in maternal health care program. Purpose of this study was to develop efforts to reduce Maternal Mortality Rate (MMR) based on performance prism in Lumajang. This study was an observational study with descriptive and quantitative approach and cross sectional study design. The data of Key Performance Indicator (KPI) was analized with Analytical Hierarchy Process method. The study was conducted in three health centers in Lumajang with low, medium, and high MMR categories. The respondents were the key stakeholders of maternal health care programs. Identification of stakeholders satisfaction and contribution resulted in the formulation of KPI maternal health services program in Lumajang as much as 23 KPI that consist of 14 regulator KPI, 5 employee KPI, and 4 intermediaries KPI. The conclusion is performance improvement of maternal health care programs may affect the reduction in the number of maternal deaths.

  Keyword: Performance prism, stakeholders, Maternal Mortality Rate, Maternal and Child Health (MCH)

ABSTRAK ANALISIS PERFORMANCE PRISM SEBAGAI DASAR PENYUSUNAN UPAYA PENURUNAN ANGKA KEMATIAN IBU (AKI) DI KABUPATEN LUMAJANG

  Tren Angka Kematian Ibu (AKI) di Kabupaten Lumajang sejak Tahun 2013 sampai dengan bulan Juni 2018 cenderung fluktuatif. Pada Tahun 2013- 2016 AKI di Kabupaten Lumajang selalu berada di atas target kabupaten yaitu sebesar 102 per 100.000 kelahiran hidup. Jika dibandingkan dengan jumlah kematian pada periode yang sama pada Tahun 2017 maka dapat diperkirakan masih akan terjadi kenaikan AKI sampai dengan akhir Tahun 2018. Berdasarkan rekomendasi Kementerian Kesehatan, penurunan AKI dapat dicapai dengan peningkatan cakupan dan kualitas pelayanan kesehatan ibu hamil dan bersalin serta peningkatan kemitraan dengan seluruh stakeholder yang terlibat. Oleh karena itu peneliti mencari penyebab masalah tingginya AKI di Kabupaten Lumajang dari sudut pandang stakeholder program pelayanan kesehatan ibu. Tujuan penelitian ini adalah menyusun rekomendasi upaya penurunan Angka Kematian Ibu (AKI) berdasarkan performance prism di Kabupaten Lumajang. Jenis penelitian ini adalah penelitian observasional dengan metode deskriptif dan pendekatan kuantitatif serta disain penelitian cross sectional. Data KPI dianalisis dengan metode Analytical Hierarchy Process (AHP). Responden dalam penelitian ini adalah stakeholder kunci dari program pelayanan kesehatan ibu. Identifikasi kepuasan dan kontribusi stakeholder menghasilkan rumusan KPI program pelayanan kesehatan ibu di Kabupaten Lumajang sebanyak 23 KPI yang terdiri dari 14 KPI regulator, 5 KPI employee dan 4 KPI intermediaries. Kesimpulan dari penelitian ini adalah peningkatan kinerja program pelayanan kesehatan ibu di Puskesmas dapat mempengaruhi penurunan jumlah kematian ibu di wilayah kerja Puskesmas.

  Keyword: Performance prism, stakeholder, Angka Kematian Ibu, Kesehatan Ibu dan Anak (KIA)